Phil Morse - North Carolina Journal for Women

Grief and Beyond—Some Facts about Suicide,
Survivor Issues, Ways to Prevent Suicide, and
National, State, and Local Resources

by Philip S. Morse

Official statistics show that more than 31,000 Americans kill themselves every year. The actual figure is probably higher. Although there are no official statistics on attempted suicides, it is generally estimated that there are about 25 attempts for each death by suicide. That means that more than 775,000 attempted suicides occur in this country every year. The non-fatal suicide attempts all too often result in serious injuries and economic loss to our society.

The estimated number of people presently left behind after a completed suicide is approximately 5 million. If one adds in a wider circle of more casual acquaintances, business associates, and neighbors, the number is considerably higher. Surviving family members and friends not only suffer the trauma of losing a loved one to suicide, but are themselves at potentially higher risk of suicide and emotional problems in ensuing years.

About 60 % of deaths from suicide each year occur among people with major depression. A meta-analysis and literature review indicates that suicide occurs in patients with major depression 20.4 times more frequently than in the general population.*

In this country suicide is the third leading cause of death among young people, ages 15–24, and is the eleventh leading cause of death among all persons, while for men over 65 the rate is six times greater than the general population. Men are also four times more likely to complete suicide than women.**

Worldwide, suicide takes a sharp toll in all countries. With approximately one million suicides every year, that represents more lives lost than in all wars and homicides combined. A recent World Health Organization report estimates that suicide was the cause of 1.8 percent of the world’s 54 million deaths in 1998.† Rates of suicide among the young have been increasing throughout the world. Figures for men and women between the ages of 15 and 44 show that suicide is the second leading cause of death among women and the fourth leading cause among men.‡

Suicide cuts across all ages and knows no economic, social, or ethnic boundaries. Perhaps the most unsettling aspect about suicide is its unpredictability. So far, no one has been able to devise a totally reliable set of predictable indices that can identify those prone to suicide. Individuals who come from incredibly difficult circumstances do not choose to end their lives while those who seem to be in much more favorable situations sometimes choose that route. About the only generalization that seems to be true is that about 90% of people who complete suicide have some sort of mental illness or have been treated for some psychiatric disorder.

Survivor Issues

On a more human level, what are the deepest feelings of those who are left behind, i.e., the survivors of suicide? Very little has been written on the central impact that suicide has on the very fabric of the survivor’s being—one’s potential for knowing joy again, issues of self-esteem, or how one moves on and reassembles the pieces of one’s life after the suicide. Obviously, grief and all its manifestations are a very real issue for anyone who has lost someone to suicide but, beyond that, how do survivors manage to go on with their lives in the face of something that has crashed through the boundaries of anything they have ever experienced and that has shattered all known patterns?

Many survivors have a real sense of failure. In some way, they feel that they must have done something catastrophically wrong. It is very hard not to blame oneself totally for what happened. When people say that the deceased was “sick,” that depression was the cause, that no one can be responsible for another person’s life, the words usually ring hollow, because as the captain of a ship feeling responsible for what happens on board, it is little consolation to hear that sort of “comfort.” Parents especially often feel intense failure when their son or daughter completes suicide.

Another is the constant, underlying feeling of melancholy—a life is gone and many others’ altered forever. The hopes and aspirations of an entire family have run seriously amiss. And what can cause additional grief is to see close family members grieving when there’s not a great deal that one can do in the early stages of mourning except to simply be there.

In the early stages, everyone continues to go through the motions of living but each is now saddled with a private grief that is difficult, if not impossible, to ameliorate. It often becomes a confrontation with the essential separateness of life itself. Before the suicide, a family might have had the illusion of “togetherness” but now each is forced to deal with a common loss that is made even more difficult because everyone often ends up feeling so alone. That is probably why up to 80% of marriages end in divorce after the death of a child by suicide.

The finality of suicide precludes the possibility of second chances, of fixing things that went wrong and looking forward to the future because, for the person who completes suicide, there is none. It’s like a moment of horror frozen in time with everyone having to reassemble the pieces, deal with the aftermath, and, somehow reinvent his or her own life.

Finally, the stigma of suicide sometimes hangs over the survivors. There are times when the latter are convinced that people are judging them and some sort of vague shame registers in sort of an ill-defined way. The survivors begin to doubt who they thought they were and what kind of status they had in the community. Even more insidious, the self-esteem of the survivor can suffer and subsequent emotional problems can begin to surface.

Suicide Prevention

The following are warning signs of suicide:

• Threats of suicide, or talking of wanting to hurt or kill him/herself
• Talking of death or dying, preoccupation with themes of death (particularly if this is a change for the person
• Previous suicide attempts
• Recent suicide death of a friend or relative
• Dramatic mood changes or changes in personality such as nervousness, sudden bursts of anger, irritability, violence, unexplained crying
• Withdrawal from friends and family, increased isolation
• Self-destructive behavior, increased risk-taking and recklessness
• Increased substance abuse or depression
• Giving away prized possessions
• Lack of interest in the future (hopelessness), no or few reasons for living or purpose in life

Note: although no single sign necessarily means an imminent suicide, the above can be indicative of the need for increased vigilance.

If You Are Worried that Someone Is Considering Suicide:

TAKE ANY MENTION OF DEATH OR SUICIDE SERIOUSLY. If someone you know talks about suicide, asking direct questions about how, when and where he or she intends to commits suicide may help prevent the attempt.

It is natural to fear that a question about suicide may anger or offend someone you care for—or even that it may put the idea of suicide into the person’s mind. However, you cannot make someone suicidal by asking straightforward, caring questions. A person considering suicide may welcome the chance to talk about these feelings.

If someone is threatening to commit Suicide

• Take the person seriously. Stay calm and let the person know you are willing to listen.
• Involve other people. Don’t try to handle the crisis alone or put yourself in danger. Get help from a suicide hotline such as the National Suicide Prevention Lifeline (1-800-273-8255) or HopeLine (1-800-844-7410) or call 911 if necessary. Contact the person’s family, psychiatrist, therapist, doctor or others who are trained to help
• Express concern. Ask direct questions and listen. Try to find out if the person has a specific plan for suicide and what it is.
• Be understanding, not judgmental. Remind the person that suicide is a permanent solution to a temporary problem and that there is help and hope.
• Never promise confidentiality. You may need to speak to the person’s doctor in order to protect the person. Secrecy can endanger your loved one’s life.
• If possible, don’t leave the person alone until you are sure he or she is in the care of professionals.

Available Resources

There are a number of national, state, and local agencies and organizations which can help individuals and groups with issues pertaining to suicide:

Prevention Resources

NATIONAL

The American Association of Suicidology (AAS): www.suicidology.org.
American Foundation for Suicide Prevention (AFSP): www.afsp.org.
International Association for Suicide Prevention: www.iasp.info.
The Jason Foundation: www.jasonfoundation.com.
The JED Foundation: www.jedfoundation.org.
Kristin Brooks Hope Center, National Hopeline Network: www.hopeline.com.
Light for Life Foundation International: www.yellowribbon.org.
National Organization for People of Color Against Suicide, Inc. (NOPCAS): www.nopcas.com.
National Strategy for Suicide Prevention: www.mentalhealth.samhsa.gov/suicideprevention
QPR Gatekeeper: www.qprinstitute.com.
The Samaritans: www.samaritansnyc.org.
SA\VE--Suicide Awareness\Voices of Education: www.save.org.
SPANUSA (Suicide Prevention Action Network USA): www.spanusa.org.
TEACH (Teen Education and Crisis Hotline): www.teachhotline.org.
LivingWorks Education, Inc.: www.livingworks.net.
The Link's National Resource Center for Suicide Prevention and Aftercare: www.thelink.org.

STATE/LOCAL

North Carolina's Youth Suicide Prevention Plan: www.communityhealth.dhhs.state.nc.us/Injury/YouthSuicidePlan.pdf.
National Alliance for the Mentally Ill (North Carolina): www.naminc.org.
Triangle Consortium for Suicide Prevention (TCSP): www.trianglesuicideprevention.org. Brings together a network of health services dedicated to the promotion of efforts related to education, awareness, prevention, and postvention of suicide in the community.

Postvention Resources (for survivors of suicide)

NATIONAL

Compassionate Friends: www.compassionatefriends.org.
The Link's National Resource Center for Suicide Prevention and Aftercare: www.thelink.org.
Parents of Suicides: www.parentsofsuicide.com.
The Sibling Connection: www.counselingstlouis.net.
Sibling Survivors: www.siblingsurvivors.com.
The American Foundation for Suicide Prevention: www.afsp.org.
"Beyond Surviving," by Iris Bolton (PDF file)

STATE/LOCAL

Survivors of Suicide Self-Help Group: www.trianglesos.org (meets every Thursday from 6:30--8:00 PM on the 3rd floor of Hospice of Wake County. Call 919-828-0890 for more information).
Lifeline (for those who have lost someone to suicide): http://www.dhcc.dukehealth.org, click on Bereavement Services. For more information on support group sessions, call 919-644-6869. Ten week support group meets from January 25-March 29, 2006. Registration required.

Information Resources

Frequently Asked Questions About Suicide: www.nimh.nih.gov/suicideprevention/suicidefaq.cfm.
In Harm's Way (NIMH Overview of the Problem of Suicide): www.nimh.nih.gov/publicat/NIMHHarmsway.pdf.
National Mental Health Assocation: www.nmha.org.
OASSIS: www.oassis.org.
Suicide Facts and Statistics: www.nimh.nih.gov/suicideprevention.suifact.cfm.
Suicide Information and Education Center (SIEC): www.suicideinfo.ca.
Suicide Prevention Resource Center. www.sprc.org.
SA\VE--Suicide Awareness\Voices of Education: www.save.org.
North Carolina's Youth Suicide Prevention Plan: www.communityhealth.dhhs.state.nc.us/Injury/YouthSuicidePlan.pdf.

*Fawcett, Jan. “Depressive Disorders.” Lifesavers, Vol. 18 No. 2. New York: **American Foundation for Suicide Prevention, Summer 2006.
Rabin, Roni. “Health Disparities Persist for Men, and Doctors Ask Why.” New York Times: November 14, 2006, D6.
†Jamison, Kay. Night Falls Fast. New York: Knopf, 1999.
‡Ibid.


Philip S. Morse is a professor emeritus at the State University of New York at Fredonia and am the co-founder of the annual Survivors of Suicide Conference in the triangle area of North Carolina and also the founder of the Triangle Consortium for Suicide Prevention (TCSP) www.trianglesuicideprevention.org. I live in Fearrington Village with my wife Judith.	Dec 06 - Grief and Beyond—Some Facts about Suicide, Survivor Issues, Ways to Prevent Suicide, and National, State, and Local Resources